Q&A: Confused about the health care law? Here's some answers to common questions

Sunday

Mar 28, 2010 at 12:01 AM

Whether you're for or against it, the historic health care reform President Barack Obama signed into law last week could be a prescription for confusion. Here's a primer on how it'll work in the Bay State:

Anika Clark

Whether you're for or against it, the historic health care reform President Barack Obama signed into law last week could be a prescription for confusion. Here's a primer on how it'll work in the Bay State:

Q: When do benefits go into effect?

A: Massachusetts' already-reformed health care system will continue uninterrupted, although different federal provisions will gradually come online, such as the requirement that plans offering dependent child coverage extend this until the age of 26 (effective within six months).

Q: I'm currently insured with MassHealth. Will I have to do anything different to sign up for the new federal health insurance?

A: No.

Q: When will I be able to purchase insurance on the state exchange?

A: Massachusetts already has a state exchange — the Health Connector — which was created as part of the state's health care reform legislation in 2006. The state-based exchanges outlined in the federal reform are insurance marketplaces, where people and small employers can buy coverage and those in lower income brackets can qualify for subsidies. The Health Connector is an independent state agency that offers Commonwealth Choice (a menu of Connector-approved plans) and Commonwealth Care (low-cost or no-cost health care, subsidized with state and federal dollars). Under the new federal health care system, Health Connector will continue, uninterrupted, as Massachusetts' exchange. Consumers in other states will be able to buy insurance on other state exchanges in 2014.

Q: Is this law now permanent? Is there any way it can be reversed or overruled?

A: Now that the president has signed health care reform into law, it would take an act of Congress to repeal it. Republican critics are vowing to do just that. By Tuesday, attorneys general from 14 states had filed suit in federal court against federal health care reform.

Q: Will the federal law totally replace the state system or can the state choose to keep any of its rules?

A: "The federal law will not totally (replace) the Massachusetts system," Richard Powers, spokesman for the state's Health Connector wrote in an e-mail. Federal health care reform was modeled in large part after Massachusetts, but some differences exist between the two systems. Among them is the exemption from tax penalties, in the federal system, for businesses employing 50 or fewer people. Massachusetts requires businesses with 11 or more full-time equivalent employees to provide health insurance or face penalties. The two systems also have different affordability schedules — minimum thresholds at which individuals who aren't recieving health insurance from their employers must purchase insurance or face penalties. However, Powers said, in Massachusetts, that affordability schedule is reviewed annually. "There will more than likely have to be some decisions made by the (state) Legislature in areas where there are differences between state and federal law," Powers wrote. For example, with the implemention of new federal tax penalties on certain uninsured individuals or employers not offering insurance, the state government will need to determine whether to keep its own state tax penalties, revise them or eliminate them.

Q: Are there any Massachusetts residents who are required to have insurance under the state plan who will fall outside federal regulations?

A: This will depend on what the state's affordability schedule — reviewed every year — looks like in 2014.

Q: If I purchase insurance on the state exchange, how do I get the federal subsidies?

A: Massachusetts residents already receive full or partial subsidies through Commonwealth Care, the state's no-cost or low-cost health program. "Those who get partial subsidies pay the balance of their monthly premium to the Connector, which then sends that money to the health plan," Powers wrote. According to Sen. John Kerry, reform will provide $4.1 billion in premium and cost-sharing tax credits for private health insurance to Bay State residents from 2014 to 2019. The infusion of these federal subsidies should, in turn, lessen the amount that's needed to be provided by the state, according to Kerry.The federal subsidies are slated to become available in 2014.

Q: Does anything in this plan keep premiums or deductibles from going up and up and up?

A: Here's where the offices of Sens. Kerry and Scott Brown and Rep. Barney Frank fall on this issue:

Kerry: "Absolutely. This bill helps everyone, not just the uninsured. Insurance companies will be prohibited from charging excessive premiums based on health status, gender or age. The insurance exchanges will act as purchasing pools to create the leverage necessary to drive down premiums. Insurers have to spend at least 80 percent of their premium dollars on medical care instead of inflating premiums due to wasteful administrative overhead and profits. And the law holds insurance companies accountable for unreasonable rate hikes. Any company with excessive or unjustified premium increases may not be able to participate in the health insurance exchanges.

From Felix Browne, spokesman for Sen. SCOTT BROWN: "Congress passed a health care bill that adds an estimated $2.6 trillion to the national debt, a half a trillion in tax increases, and a half a billion in Medicare cuts — to say nothing of the immediate increase in premiums and the immediate threat to jobs and the economy in the Commonwealth. With more than 200 medical device manufacturers in Massachusetts, employing tens of thousands of workers, this health care bill will put an additional tax on these businesses and will cost good paying jobs. Senator Brown believes that this bill should be repealed and replaced with solutions that would actually lower the cost of health care for Massachusetts families."

From Diego Sanchez, Legislative Assistant to REp. Barney Frank: "It does. All U.S. residents are helped by this bill, whether insured today or not. The practice of charging more based on sex, age or health status by insurance companies is halted by this law. At least 80% of insurance companies' premium dollars must be spent on medical care, and unreasonable rate hikes will be prohibited by this law."

Q: Can I buy a plan on the state exchange and receive subsidies, if I qualify, and the benefits are better than the plan I have at work?

A: The exchanges are intended for people whose employers don't give them health insurance and small businesses. But they are open to people if their employer-provided coverage doesn't meet pre-set standards of affordability. People still need to fall within income brackets to receive federal subsidies when they go into effect in 2014.

Q: Will I be able to choose my own doctor and hospital under the federal program?

A: Yes. Selection of doctors and hospitals will still be determined by the plan itself or the structure of MassHealth or Medicare.

Q: I have a flexible spending account at work. Will it still be available under the federal program?